H1N1 Redux: Myths and Legends

About 1 out of 3 calls to Children's National Medical Center diabetes nurse educators are about H1N1 flu vaccine. The following are the most common queries:

Does my child with diabetes need to get the flu vaccine?

Do I get the flumist or the shot?

Why do I need the flu shot? Is my child with diabetes immunocompromised?

Isn't the shot really dangerous? Is it experimental?

Will I get the flu if I get the shot/mist?

Is the flumist more dangerous because it is a live attenuated vaccine (weakened virus that does not cause illness)?

Is there a greater risk of getting a neurological disorder if I get the flumist/shot?

Does my child need to stay home from school if there are an increasing number of students with H1N1?

Let's start answering these inquiries:

NEED vs. SUGGESTION- your child with diabetes does not absolutely need to get the flu vaccine as long as you have been fully informed of the risks of the flu vaccine vs. the risk of the flu illness. See the following discussion.

The American Diabetes Association has indicated in its documents that it is recommended that people with diabetes get the flu shot vs. the flumist. (people over age 49 must get the shot anyway). However, 90 percent of people with diabetes are type 2 and older individuals who have accompanying medical conditions that could place them at greater risk (although small) if they get the live weakened virus in the flumist. As such, children with diabetes fall into the category of "people with diabetes." AND,

Children with diabetes are not immunocompromised just because they have diabetes. However, if they get a virus or become ill, they are at risk for blood sugar fluctuations along with the development of ketones and possibly DKA. The idea is to avoid the possibility of getting H1N1 and thus prevent complicating hyper/hypoglycemia and ketones and DKA. Since the flumist is a live, weakened virus, there is a slight risk that the child could become mildly ill and develop blood sugar issues. If your child had asthma, I would NOT recommend the flumist, as that may trigger an asthma attack. Several of my patients have already received the flumist without problems, but that is merely anecdotal evidence. I leave the decision to the family after fully informing them of the benefits and risks of each choice and the ADA recommendations.

The H1N1 shot is not experimental per se. It is made in the exact same manner as the seasonal flu shot, but with the H1N1 flu antigens so you may become immune to H1N1. However, this is the first time that this particular strain is used in the vaccine. The trouble with the swine flu vaccination in the 1970s was due to the method in which the flu vaccine was manufactured. That method is no longer employed.

You may get some milder symptoms of the flu after being vaccinated with either the flumist or flu shot, including muscle aches, mild fever, etc.

The flumist has the potential to cause more symptoms because it is a weakened virus; but is a real concern in patients that have lung conditions such as asthma, emphysema etc.

The risk of a neurological disorder such as Guillain-Barre is very small. My sources at Children's National have indicated that the risk of G-B syndrome with the vaccine is 1/100,000 and after suffering from the flu- 4/100,000. There is no real statistical difference. But it is a rare possibility and if you are the 1 in 100,000 it is 100 percent for you. I understand the fear and concern. To my knowledge, there have been no reports of dystonia in the past resulting from previous flu vaccines.

Lastly, the ADA suggested in a recent notice that a family might consider keeping their child with diabetes home if there is an H1N1 flu outbreak in school. It is tempting; but, my unfortunate suspicion is that H1N1 will be around for the fall, winter, and perhaps spring with intermittent outbreaks. The hope is that if most people become immunized, there will be "herd" immunity in which most people will be protected from H1N1. As always, I suggest that you do what you need to do to sleep at night. Use common sense and make rational decisions. Keep in mind that in most cases the disease is mild and that you would need to do the very same things in terms of blood sugar and ketone monitoring if your child had another virus. However, if your child is vomiting and unable to keep fluids down in association with ketones, you must get medical support.

Lastly, buy stock in those handwashing cleansers and use liberally and often to prevent contagion as much as possible. I would be happy to address any other questions, comments.